Reduction is a surgical procedure to restore a fracture or dislocation to the correct alignment. When a bone fractures, the fragments lose their alignment in the form of displacement or angulation. For the fractured bone to heal without any deformity the bony fragments must be re-aligned to their normal anatomical position. Orthopedic surgery attempts to recreate the normal anatomy of the fractured bone by reduction of the displacement or the fracture.
After reduction, the reduced fracture must be fixed. Fracture fixation is carried out for stabilizing the reduced fractured bone in order to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity.
Fracture reduction is carried out by either closed or open methods. In open reduction, the fracture fragments are exposed surgically by dissecting the tissue. While in closed reduction, the bone fragments are reduced without surgical exposure of the fragments. In the closed reduction method, bone fragments are indirectly manipulated by different methods, such as, traction of the whole limb on a fracture table or using hanging weights; or distraction of bone fragments indirectly, using mechanical distractors attached to the bone fragments by some drilled pins through the skin far from the fracture site.
In closed reduction, the fixation is carried out by methods, such as, intramedullary fixation using intramedullary nailing, in which, the integrity of the fracture site soft tissue is preserved. There may be advantages in preserving the integrity of the soft tissue of the fracture site in terms of cosmetics, blood loss, and rate of union, time of surgery, rehabilitation and medical costs.
After reducing the long bone fractures, a common preferred fixation method may include internal splinting by intramedullary nails that are inserted into the bone medulla from one end of the fractured bone far from the fracture site. In this method one end of the bone medullary canal is opened and a guide wire is passed through the bone fixing and aligning the bone fractures in the required position. This is the critical stage of intramedullary nailing of a long bone especially femur, because of its large soft tissue mass.
Closed nailing method is often used for treatment of long bone fractures. In this method a fracture table for fastening the patient, a fluoroscopy set, and devices for bone manipulation to achieve bone reduction are needed.
In spite of all the devices and facilities used in closed nailing method, the method is time-consuming, since it takes a long time to pass the guide wire through the medullary canal as the initiating critical step of the surgery. Exposure of x-ray radiation to the patient and staff is also a disadvantage of the method.
Nowadays mechanical distractors are used for bone reduction, in which few pins are used for the attachment of the mechanical distractor to the bones near the fracture site in order to avoid any surgical incisions and using a fracture table.
There is, therefore, a need in the art for a distractor capable of distracting the bone parts dynamically, so that the distracted parts can be freely manipulated and fixed in the desired position for reduction.